Joan Vass Womens Mary Leather Loafer With 1 Inch Heel See More Colors and Sizes Taupe 9xuC4KUiFJ

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Joan Vass Womens Mary Leather Loafer With 1 Inch Heel (See More Colors and Sizes) Taupe 9xuC4KUiFJ
  • Leather
  • WALK WITH ELEGANCE: Designed in New York and handcrafted in Portugal, the Mary loafer is made with premium Napa leather upper which offers a fine, smooth finish, for a luxurious pair of shoes that's truly sophisticated
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  • VERSATILITY AT ITS FINEST: With its functionality, style, and comfort, the Mary loafer makes a great choice for a variety of occasions. It's easy to pair with office attire, a silky blouse and trouser set or even a casual dress. You can imagine yourself wearing them for a day in the office, during leisurely city excursions, not to mention for parties and special occasions
  • TRUSTED BRAND: Joan Vass offers the premium quality that you're looking for to suit your style and personality. Keep your outfit chic and trendy while staying comfortable wearing these fashionable loafers!
Joan Vass Womens Mary Leather Loafer With 1 Inch Heel (See More Colors and Sizes) Taupe 9xuC4KUiFJ Joan Vass Womens Mary Leather Loafer With 1 Inch Heel (See More Colors and Sizes) Taupe 9xuC4KUiFJ Joan Vass Womens Mary Leather Loafer With 1 Inch Heel (See More Colors and Sizes) Taupe 9xuC4KUiFJ

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A Health Information Exchange, or HIE, is a way of sharing your health information among participating doctors’ offices, hospitals, care coordinators, labs, radiology centers, and other health care providers through secure, electronic means. The purpose is so that each of your participating healthcare providers can have the benefit of the most recent information available from your other participating providers when taking care of you. Information flowing through the HIE can also be made available to researchers with appropriate consent through a careful review and approval process. When you opt out of participation in the HIE, doctors and nurses will not be able to search for your health information through the HIE to use while treating you and your information will not be available for research. Your physician or other treating providers will still be able to select the HIE as a way to receive your lab results, radiology reports, and other data sent directly to them that they may have previously received by fax, mail, or other electronic communications. Additionally, in accordance with the law, Public health reporting, such as the reporting of infectious diseases to public health officials, will still occur through the HIE after you decide to opt out. Controlled Dangerous Substances (CDS) information, as part of the Maryland Prescription Drug Monitoring Program, will continue to be available through the HIE to licensed providers.

You have several options for opting out of the CRISP HIE; you can select one below.

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What Is Health Information Exchange?

Health Information Exchange, or HIE, is a way of instantly sharing health information among doctors’ offices, hospitals, labs, radiology centers, and other health organizations. HIE allows delivery of the right information at the right time, providing safer, more timely, efficient, patient-centered care. The CRISP HIE allows the providers treating you in a hospital or doctor’s office to access your medical history. For example, providers can review recent lab results whether the test was conducted at your primary care provider, at the hospital, or at participating labs across the state.

What Are The Benefits Of Having An HIE?

Often, when providers need to share health information about a patient, the process is difficult and usually involves phone calls, frequent mailings and faxes. Gathering health information on a patient can take hours or even weeks, and sometimes the information is not available at all. Errors are common. Throughout the HIE, providers have immediate access to important information. The HIE helps to avoid unneeded tests and procedures, medical mistakes, and costly medical bills.

How Is My Medical Information Kept Private?

Protecting patient information in the CRISP HIE is a priority. CRISP follows all state and federal privacy and security laws to protect patient health information. The Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach Notification Rules are the main Federal laws that protect your health information. CRISP considers the privacy and security protections outlined by these laws to be minimum standards, and many of our policies go above and beyond what is really required by law. While there are many benefits to participating in the HIE, exchanging information electronically also has risk. Potential risks include: errors in clinical data, breach of information, and inappropriate use. CRISP is confident that many of these risks are mitigated by protections and security process that are in place. If you have additional questions about the risk of participating in the HIE, please contact the CRISP privacy and security officer Brandon Neiswender at [email protected] .

How Do I Know Who Has Accessed My Records?

Patients can request a list of participating users that have accessed their medical records. Requests should come directly to CRISP and must include first name, last name, date of birth, and address. If a patient deems a user was unauthorized to view their records, CRISP will begin an investigation with the organization involved.

How Is My Information Used to Support Research?

Every week, CRISP receives millions of pieces of healthcare data. All that information could help all of us understand how to make healthcare work better. Some call this creating a Learning Health System . CRISP makes HIE data available to researchers who work at hospitals that use CRISP. Some of the world’s leading health researchers at places like Johns Hopkins, the University of Maryland and MedStar participate in CRISP. Our first permitted use is for research on people who sign an agreement to give researchers access to their data. Over time, we may add new uses that involve data from larger groups of people where specific consent is not possible or practical. In those uses, we will remove the information that tells us who you are (like name, address and date of birth). To learn more, go to the CRISP Research Initiative page.

Information Handling Practices

In the course of CRISP making the query-based exchange functionality available to its customers, it transmits and stores information only to enable its customers’ use of CareQuality’s initiative of sharing patient data on a national framework, and for the primary purpose of treatment of its customers patients.

Contact Us

To anonymously report security or privacy incidents or concerns, please call Michael Widerman, the CRISP Director of Security, at 443-741-4614.

Fig. 3.

Ratio of T cells expressing different adhesion molecules within effusions and in the peripheral blood. T cells expressing the given marker were analyzed in patients with nonmalignant cirrhotic ascites ( = 17), malignant ascites ( = 11), and malignant pleural effusions ( = 15). Percentages of CD4+ (□ and ▪) or CD8+ ( and ) T cells expressing the given homing receptor were determined using four-color flow cytometry and gating on morphologically defined lymphocytes, CD3+ T cells, and CD4+ or CD8+ cells. In each patient an effusion:peripheral blood ratio was calculated for all lymphocyte subsets. represent mean values of this ratio and SE of means. ∗ indicate significant differences in cancer patients when compared with patients with nonmalignant effusions (*, < 0.05; **, < 0.01; ***, < 0.001). □, CD4+ T cells, cirrhotic patients. , CD8+ T cells, cirrhotic patients. ▪, CD4+ T cells, cancer patients. , CD8+ T cells, cancer patients.

T-cell mediated control of tumors is thought to be promoted by type 1 cytokine responses [ i.e. , interleukin (IL)-2, IFN-γ, and tumor necrosis factor α] and impaired by type 2 cytokine responses ( i.e. , IL-4, IL-5, IL-6, IL-10, and IL-13). To elucidate the cytokine pattern presumably produced by the TAL of our patients, we analyzed the expression of CXCR3 and CCR4 on these cells. The effusion:peripheral blood ratio of potentially type 1 polarized CXCR3+ T cells was comparable in patients with malignant and nonmalignant effusions. In contrast, we observed an increased enrichment of CCR4+ T cells, presumably being type 2 polarized, within the effusions of both patient groups with malignancies (Fig. 3) .

Finally, we examined the effusion:peripheral blood ratio of different memory/effector T-cell subtypes, defined by their expression of CD45RA and CCR7. In both patient groups we observed an enhanced enrichment of CCR7+CD45RA+ “naïve” and CD45RA-CCR7+ “central memory” T cells within the malignant effusions. In marked contrast, the effusion:blood ratio of “memory effector” type CD8 + T cells was reduced in patients with malignant pleural effusions, and enrichment of terminally differentiated CD45RA+CCR7− CD4 + and CD8 + T cells within the malignant effusions was dramatically impaired in patients with malignant peritoneal and pleural effusions (Fig. 4) .

Fig. 4.

Ratio of naïve:memory T-cell subsets within effusions and in the peripheral blood of patients with nonmalignant ascites ( = 17), malignant ascites ( = 11), and malignant pleural effusions ( = 15). Percentages of CD4+ (□ and ▪) or CD8+ T cells ( and ) expressing the given combination of markers were determined using four-color flow cytometry and gating on morphologically defined lymphocytes, CD3+ and CD4 or CD8. Costaining with CD45RA and CCR7 was applied to determine the composition of different memory T-cell subsets. In each patient an effusion:peripheral blood ratio was calculated for all lymphocyte subsets. represent mean values of this ratio and SE of means. ∗ indicate significant differences in cancer patients when compared with patients with benign effusions (*, < 0.05, **, < 0.01, ***, < 0.001). □, CD4+ T cells, cirrhotic patients. , CD8+ T cells, cirrhotic patients. ▪, CD4+ T cells, cancer patients. , CD8+ T cells, cancer patients.

We also analyzed differences in the percentages of lymphocyte subpopulations within the effusion of the three groups. Differences between groups were most pronounced in patients with malignant pleural effusions when compared with patients with benign ascites. These patients showed elevated percentages of tumor-associated CD4 + T cells and reduced levels of CD8 + T cells within their pleural effusion (Table 2) . However, both patients with malignant ascites and patients with malignant pleural effusions showed significantly lower levels of NK cells than patients with benign peritoneal effusions. In addition, patients with malignant pleural effusions evidenced drastically reduced percentages of potentially highly cytotoxic CD56 + NK T cells when compared with effusion-infiltrating lymphocytes of patients with nonmalignant ascites.

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David Zuckerman, with contributions from Holly Jo Sparks, Steve Dubb, and Ted Howard

The Democracy Collaborative’s latest report, , provides an in-depth look at six hospitals in five cities that are rethinking their economic and community engagement strategies. These hospitals have recognized that health is more than just treating the patients that come through their doors and are beginning to adopt an “anchor institution mission” that can help build not only more prosperous, but also healthier communities.

Detroit's "Big Three" are no longer Ford, General Motors, and Chrysler. Today, its three largest private employers are instead Henry Ford Health System, Detroit Medical Center, and Wayne State University. Detroit is but one example of a massive shift that is taking place: nonprofit universities and hospitals have become the dominant economic linchpins in many communities across the country.

As we read Zuckerman’s landmark report, we can appreciate the powerand possibility within a hospital anchor institution model. We can learnimportant lessons from those leading the effort, and share on how creativitycan support models of health promotion, which promise to moveus beyond the decaying economic model at present.

—Jamie Harvie, Executive Director, Institute for a Sustainable Future

is such an interesting and important report. It reminds me of the work of [community development pioneer] John McKnight several decades ago this could have just as lasting an impact.

Julie Trocchio, Senior Director, Community Benefit and Continuing Care, Catholic Health Association

This transformation brings with it important opportunities. Unlike highly mobilecorporations, universities and hospitals are geographically “anchored” to their communities.America’s nonprofit hospitals alone have revenues of more than $650 billionand assets of $875 billion and are often situated in struggling neighborhoods.

Hospitals Building Healthier Communities provides case studies of hospitals and health systems beginning to grapple with the challenge of embracing an anchor institution mission. Those case studies, andother best practices compiled from across the nation, provide a resource for—andpose a challenge to—hospitals throughout the country. Its findings expand the conversationand should spur new strategic economic approaches not just by hospitals,but also local philanthropy, community-based organizations, and policymakers.

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Read report author David Zuckerman's op-ed in The Baltimore Sun (with Gar Alperovitz), "Going outside hospital walls to improve health"